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CITY OF TIGARD 41, 3`(o -I ° 3 5( PLUMBING PERMIT
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t; ; COMMUNITY DEVELOPMENT Permit #: PLM2013 00037
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2013
Parcel: 2S109DA16600
Jurisdiction: Tigard
Site address: 15284 SW OAKMONT PL
Project: Arlington Heights No. 3, Lot 85 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 85
Project Description: (1) backflow preventer 3/6/13 REPRINT permit to correct description
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
PO BOX 2386 4230 GALEWOOD ST SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
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PHONE: 503 - 387 -7577
PHONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/04/2013 $31.27
Specifics: 1 12% State Surcharge - 02/04/2013 $8.70
Plumbing •
Type of Use SF 41 ea Minimum Fee Adjustment - 02/04/2013 $41.23
Plumbing -
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20 •
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon •
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules .
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •
Issued By: 11U-4/1— Permittee Signature:
fikl ,4)Puc/4.r704i
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
. This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00037
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2013
Parcel: 2S109DA16600
Jurisdiction: Tigard
Site address: 15284 SW OAKMONT PL
Project: Arlington Heights No. 3, Lot 85 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 85
Project Description: (1) backflow preventer
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
PO BOX 2386 4230 GALEWOOD ST SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 -5945 PHONE: 503 387 -7577
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/04/2013 $31.27
Specifics: 1 12% State Surcharge - 02/04/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 02/04/2013 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
•
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by Calling 503.232.1987 or 1.800.332.2344. /
Issued By: ,51/41/10,t‘
5 /{7'�J rye 0 / Permittee Signature: O (1 7 1 P� (47 7 0kt..
IL Call 503.639.4175 Per by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Plumbing Permit Application
Building Fixtures RECEIVED
City of Tigard Reeved
II Da 4 I PGN ale / 3- C X I
�C�� Rev iew
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a 13125 SW Hall Blvd, Tigard, Ofv �3
Phone: 503.718.2439 Fax: 503.598.1960 4 2013 Plan Review
Paaut Na:
Other Permit No.:
Date.By:
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Line: 50363941
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T 1 G 1 I { Inspection D eI i j OF �GA l�t� Date Read B . f RI See Page 3 for
Internet www.hga o - 1 i S
_ information
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® New_construction I ❑ Demolition For special information use checklist r
Description I Qty. I Ea. I Total
❑ =
Addition/alteration/replacement ❑ Other New 1- 2- family dwellings ( clndes 100 ft for c connection)
... , � : a -• n. L ca utility
In a c
....�.�.:.: . : : .. _ OD - a >' : -?a;. SFR(1)bath 312.70
' •'�.: � .� ' ., : '.! C: :i:_ i.�. - _ �:2r ':4: � � .!.'� - -�• _
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 I
❑ Accessory building 5FR(3) bath 500.32
❑ Multi- family
Each additional bath/kitchen 25.02
0 Master builder ❑ Other
y - _ -- Firs sprinkler ( sq. ft.) pane 2
yiliIi;l r - ; : %:JO uk'-��NFQ�,,y'1 - J �`.2(2' X C O . ,.� Ir_ €{ ,._:�, Site utiaties:
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Job site address: / 5 2 ell �. t-f ` r yl c yL y . • p Z�_< Catch basin or area drain 18.76 ,
Thywell, leach line, or trench drain 18.76
City/State/ZIP: Ti C GL2GL L= ‘7 •) ).-}C_
Footing drain (ao. linear fl: ) • Page2
Suite/bldg. /apt. no.: I Project natn "(c 1.1 C 1G'» f"k - j (A-7-S Manufactured borne utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
.i-r1t en C/" L i f ..t r7 i� i
Sanitay sewer (no. linear R: ____) Page 2 1
' Storm sewer (no. linear ft.: ___) Page 2 '
Water service (no. linear R: _ ) Page 2 I
Subdivision: /f�� Lot n o. :
f r l � 1 v1C �7 81 . IA, :8 Fixture or item:
(/ Back low reverter 1 x 31.27 3127
Tax map /parcel no.: ..S;.. P
- 1 .,,:.n:. - - _� a _ - _ .. 1, _:�_ -:,n- ..�,., - _ .. _ _ . _ . ., Eec6watervalve I 12.51
kS., a}1 �!'4. i r i. °.c$: }.., ,S: :zs _ '.'���: __ w1i= =F 'n,:f - _
1Sail:e`.. . Jew.: :e. s:�';,:.Si n l.: ,.- ... .. s,ccr v•. v: _ _. .. t:.R i rS !.6'i ?i •.rr:3i'ii':3 clothes washer 25.02
Landscape Irrigation Back Flow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
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uilal_ .�,� pR0 ' - ..O'LYNER -e �li = : ` ` "` ' -:::
r` =:e _ Ex on tank • 12.51
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+ A.:i �?4e7'77� :�:' - - - :.i. = .:, '1'F.11'A'1 � -::�� _:. I ansi
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Name: Stone Bridge Homes NW LLC FixtturJsewer cap - l 25.02
Address: 4230 Oakwood Street Suite 100 • Floor drain/floor sink/hub 25.02
• Garbage disposal • 25.02
City/State /ZIP: Lake Oswego, OR 97035 Hose bib • 25.02
Phone: ( . ) Fax: ( ) Ice maker 12.51
2 it api r ladiiaJr :c.`'c _ iV bpi .- -- __ _ i nters arl rease
-; ' - , - , - . , :Y � ; _ _ . " - . r -. • ° r s io � g 2.5.02 n- rs�e�mi�ir':" _.. ... _. ....._. . �.... _.../77 . r, a,::,. �t�. ,I ,�
Business name: Landscape Oregon, Inc Medical gas (value: S ) Page 2 •
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Contact name: Ellen Sparrow 12.51
Roof drain (commercial) 12.51
Address: P.O. Box 2386
Siak/basinlavatory 25.02
City/State/LP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax: : (503 -) 692 -0768 Tub/shower/shower pan 12.5i
E -mail: ellena^�ylaadscapeoregon.com Urinal 25.02
:::::: =.w {`mi:"r as' :3:_ :,1 �, ,.,1 Water closet
:i �_ _ -. . , _ - - ,.. - _ 25.02
j __:�i�`� ;. ; fie - ��.t ''..Ir .,, 3�� inn.: �.:: l � : ir'i, Y:a
7 ,, : . 0 :. e_: fs::;t 1. lu,: s" .......,..,. ,..�'- r= : ,__:.. , fi :.f.�.a,r•;.1,,,:(.i u`
x. beater
.. _.. _.. ., � Wa ter3752
Business name: Landscape Oregon, Inc Water pipiag/DWV 56.29
Address: P.O. Box 2386 Other 25.02
City/State/ZIP: Tualatin, OR 97062 • Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum pewit fee: 572.50 72 50
CCB Lic.: LCB 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
• State su clarge(12 %ofpermit fee) 8.70
Authorized signatttre: ./ s7,,, e . a - /_ �-p / 3 TOTAL PERMIT FEE 81.20
Print name: Ellen Sparrow � L �I l Da(e4,21 7�� ( 7 €3 This permit application expired( a permit is not obtained with 180 days
I after it has been accepted as complete.
"Fee methodology set by Tri- Cuonty Building Industry Service Board.
I :\si tt+g'Pvm'OPl. MU- PermitApp.doc ICW1:05 440-4616T(toi0
£'d ' 89LO Z69 - £09 Uell3 e017:01 £l 1.0 qed
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